哮喘联盟

   摘要
   目的：在多中心基层医疗样本中，比较使用由基层医师开发的哮喘APGAR系统与由哮喘专家开发的哮喘控制测试(ACT™)/儿童哮喘控制测试(CACT™)对哮喘控制情况的评估差异。
   受试者和方法：一项多中心、随机、对照试验研究评估了哮喘APGAR系统在基层医疗实践中的作用。本研究为亚组研究，所纳入人群为2011年3月1日到2011年12月31日完成了ACT™/CACT™和哮喘APGAR系统的患者。采用kappa和McNemar检验法比较问卷调查结果。
   结果：共468例患者纳入本研究，基于ACT™/CACT™或哮喘APGAR系统，其中有306例(65%)被归类为未控制患者。两种评估方法的总一致率为84.4%，kappa值为0.68（大体一致），McNemar检验 P值为0.35(提示在不一致方面无显著性差异)。哮喘APGAR系统评估的哮喘控制不佳者中，23.8% (73例)未服用控制药物，76.5% (234例)很少或有时能避免导致其哮喘发生的确定触发因素。在处方了控制药物的332例患者中，116 例(35%)并没有每天使用控制药物。
   结论：在多中心基层医疗样本中，哮喘APGAR系统和ACT™/CACT™同样可评估哮喘控制情况。在超过75% (234例)的哮喘控制不佳个体中，哮喘APGAR系统识别出了一个“可操作项”，由此将哮喘控制不佳的评估与管理策略联系了起来。
 

(林江涛 审校)
MayoClinProc.2014May5.pii:S0025-6196(14)00246-8.doi:10.1016/j.mayocp.2014.02.016. [Epub ahead of print]

 

Comparing the Asthma APGAR System and the Asthma Control Test™ in a Multicenter Primary Care Sample.
 

Rank MA1, Bertram S2, Wollan P2, Yawn RA2, Yawn BP3.
 

Abstract
OBJECTIVE: To compare asthma control assessment using the Asthma APGAR system, a tool developed by primary care clinicians, in a multicenter primary care sample with the Asthma Control Test (ACT™)/Childhood Asthma Control Test (CACT™), a tool developed by asthma specialists.
PATIENTS AND METHODS: This is a substudy of a multicenter, randomized, controlled pragmatic trial that tests the effectiveness of the Asthma APGAR system in primary care practices. As part of the study, enrolled patients completed both the ACT™/CACT™ and the Asthma APGAR system between March 1, 2011, and December 31, 2011. Kappa and McNemar statistics were used to compare the results of questionnaires.
RESULTS: Of the 468 patients in our sample, 306 (65%) were classified as not controlled by the ACT™/CACT™ or the Asthma APGAR system. The overall agreement was 84.4%, with a kappa value of .68 (substantial agreement) and a McNemar test P value of .35 (suggesting no significant difference in the direction of disagreement). Of those with poor control as defined by the Asthma APGAR system, 23.8% (73) had no controller medications and 76.5% (234) were seldom or sometimes able to avoid identified triggers for their asthma. Of those who stated that they had been prescribed controller medications, 116 of 332 (35%) stated that they did not use the controller medication on a daily basis.
CONCLUSION: The Asthma APGAR system and the ACT™/CACT™ similarly assess asthma control in a multicenter primary care-based sample. The Asthma APGAR system identified an "actionable item" in more than 75% (234) of the individuals with poor asthma control, thus linking an assessment of poor asthma control with a management strategy.
 

MayoClinProc.2014May5.pii:S0025-6196(14)00246-8.doi:10.1016/j.mayocp.2014.02.016. [Epub ahead of print]